MAKING THE CASE FOR EVIDENCE-BASED LEADERSHIP
AND INNOVATION EVIDENCE-BASED DECISION-MAKING AND PRACTICE: A
Problems & Issues
A. Preventable Medical Errors: The Third Leading
Cause of Death in America
• 250,000-400,00 people die each year in the
US owing to preventable healthcare errors
B. Clinician Burnout, Depression, and Compassion
Fatigue
• 50% of clinicians in the US are currently by
burnout, depression, and compassion
fatigue; as a result, the quality and safety
of healthcare are being compromised as
healthcare are being compromised as
health professionals who are experiencing
poor mental and physical health are at
greater risk for making medical errors
• Depression- identified as the leading cause
of medical errors in nurses
C. Gross Domestic Product vs. Outcomes
• Gross domestic product (GDP) is an
economics term that represents the total
value of the goods and services of a
country produced over a specific time.
D. Need for Emphasis on “So What” Outcomes
• “So what” outcomes are factors that are
highly significant ot the current healthcare
system, including rehospitalization and
complications that are currently
reimbursed (e.g. falls, pressure ulcers), as
well as costs
E. The Social Determinants of Health
• These are conditions in which people are
born, grow, live, work and age; factors
aside from healthcare
F. Small Percentage of Healthcare Start-ups being
founded by Clinicians
• *if healthcare leaders are not involved in
the creation of new technologies, products,
processes, and services that are being
developed, then these leaders are
essentially allowing no healthcare
professions to determine the future of
healthcare.
• Clinicians should be allowed to provide
meaningful input into the future of
healthcare
MUST FOR LEADERS
*The innovative leader knows it’s always best to start with
the evidence. Findings from a strong body of research
indicate that
• healthcare quality
• population health outcomes
• costs
• clinician engagement and satisfaction
-- QUADRUPLE AIM in healthcare
*EBP has been broadened to include lifelong problem-
solving approach to the way that healthcare is delivered,
one that integrates the best evidence from high-quality
studies with a clinician’s expertise and a patient’s
preferences and values
Evidenced-Based Leadership
• a problem solving approach to leading and
influencing organizations or groups to achieve a
common goal that integrates the conscientious use
of best evidence with leadership expertise and
stakeholders’ preferences and values
Innovation
• involves creation of a solution to something when a
solution or evidence does not exist
• the process of implementing new products,
services, and/or solutions that create new value
* For an innovation to sustain, evidence must be generated
that supports its value or outcomes
Barriers from making EBP a Standard in the Healthcare
System
1. Inadequate knowledge of and skills in EBP by clinicians
2. Lack of cultures and environment that support EBP
3. Misperceptions that EBP takes too much time
4. Organizational politics and policies that are outdated
5. Limited resources and tools available for point of care
providers, including budgetary investment in
EBP
6. Resistance from colleagues, nurse managers, and leaders
7. Inadequate numbers of EBP mentors in the healthcare
systems
8. Academic programs that continue to teach baccalaureate
and master’s students the rigorous process of how to
conduct research instead of taking an evidence-based
approach to care
THE SEVEN (7) STEPS OF EBP by Melnyk and Fineout-
Overbolt (2019)
1. Cultivate a spirit of Inquiry within an EBP Culture and
Environment
*EBP should be included in the organization’s
vision, mission, and goals, staff performance evaluations,
and clinical ladders to set the expectation that all clinicians
will meet the EBP competencies
2. Ask the Burning Clinical Question in PICO(T) Format
(Patient/Population, Intervention/area of Interest,
Comparison, Outcome(s), Time)
Ex. In hospitalized older adults (P), how does using
an evidence-based fall prevention protocol (I) versus not
using an evidence-based fall prevention protocol (C) affect
fall rates (O)
In clinicians (P), how does mindfulness training (I)
versus cognitive behavioral skills-building (C) affect burnout
and turnover rates (O) 6 months after training (T)
In adults in intensive care (P), how does ambulation
(I) versus delayed ambulation (C) affect rates of ventilator
associated pneumonia (O)
3. Search for and Collect the Most Relevant Best Evidence
4. Critically Appraise the Evidence
This process includes answering the following
questions:
1. Are the results of the study valid (i.e., did the
researchers use the best methods to conduct
the study?
Study validity
• it determines whether the methods used to
conduct the study were rigorous
2. What are the results (i.e., do the results matter,
and can I get similar results in my practice; Study
reliability?
3. Will the results help me in caring for my patients
(e.g., is the treatment feasible to use with my patients;
Study applicability?
5. Integrate the Best Evidence with One’s Clinical Expertise
and Patient/Family Preferences
• Once the body of evidence from the search is
critically appraised, evaluated, and synthesized, it is
integrated with a leader or clinician’s expertise and
the patient’s preferences and values to decide
whether a practice change should be made.
Providing the patient with existing evidence and
involving the patient in the decision regarding
whether a certain intervention or treatment
performed is an important step in EBP
6. Evaluate Outcomes of the Practice Decision or Change
Based on Evidence
• An outcome is the consequence of the intervention
Outcomes evaluation
• Is absolutely critical to assess the impact of an EBP
change on healthcare quality and patient
outcomes.
Ex. complication rates, length of stay, rehospitalization
rates, and costs
7. Disseminate the Outcomes of the EBP Decision or
Change
• Include, institutional EBP rounds; poster and
podium presentations at local, regional, and
National conferences; and publications
INNOVATION-BASED PRACTICE
When evidence does not exist to support a change in care,
a leader must generate innovative solutions to address
problems in healthcare systems with a view to ultimately
improving healthcare quality and patient outcomes
HEALTHCARE IMPROVEMENT THROUGH
INTERPROFESSIONAL INNOVATION AND AN EBP MODEL
• It is a framework that can be used to improve
clinician and healthcare outcomes.
The first step in this model is assessing organizational
culture and readiness for interprofessional EBP and
innovation. After, an infrastructure should be created or
current structure strengthened to support both EBP and
innovation. EBP facilitators should be developed to work
with point-of-care clinicians at the grassroots level on how
to implement EBP to improve healthcare quality and
patient outcomes
Innovation is more than having good ideas; it adds
measurable value to a system
COMMON LEADERSHIP STYLES
A. Innovation Leadership
• Innovation Leaders create and infrastructure that
integrates innovation into the DNA of their
organization
• Employees are both empowered and encourages tp
develop innovative solutions to solve healthcare
issues for systems to operate smoothly and to
produce positive patient outcomes
• They provide the roles, decision-making structures,
physical space, partnerships, and networks that
support innovative thinking and testing
Competencies of Innovation Leaders:
1. Assessment for Innovation: Personal knowledge for
one’s propensity, ability, and skill with innovation work
2. Future focused: Actively plans for a better future and
understands the value of change
3. Value-driven: Believes new ideas will advance
performance and value
B. Transformational Leadership
• defined as a state in which leaders and followers “find
meaning and purpose in their work, and grow and
develop as a result of their relationship”
• Leaders and followers become partners in pursuing
common goals
• Transformational leaders are enthusiastic, energetic,
and compassionate
• They generate an exciting vision and inspire other to
engage in a journey to achieve that vision
• They support and encourage people within the
organization and regularly recognize and appreciate
them for their efforts
• Leaders create culture in which staff are creative,
innovative, and open to change
• Followers typically respect, admire, and trust a
transformational leader
C. Servant Leadership
• based on a focus on others along with trust, empathy,
and caring
• A servant leader practices shared power and focuses on
enhancing the growth and optimal well-being of his or
her followers
• What counts is not power, but whether those being
served become more autonomous, healthier,
independent, wiser, and likely to become servant
leaders themselves
Foundational Characteristics Central to Servant Leadership
(Spears 2010)
1. Listening
2. Empathy
3. Healing
4. Awareness
5. Persuasion
6. Conceptualization
7. Foresight
8. Stewardship
9. Commitment to growth of people
10. Building Community
D. Authentic Leadership
• transparent, confident, hopeful, optimistic, resilient and
of high moral character
• keenly aware of how they think and behave and have
firm convictions of who they are, and where they stand
on issues, values and beliefs
• they are role models, focusing on ethics, and working to
develop others
• create and sustain high-quality relationships with their
followers
• they build trust and healthy work environments
• conducts thorough assessment and objectively analyze
data for the purpose of informing their decisions
• Hold high moral and ethical standards for themselves and
are transparent in their communication
E. Autocratic Leadership
• also known as authoritarian leadership
• characterized by high control over decisions with little
input from others
• typically make decisions with little input from others
• decisions are made based on their ideas, knowledge
and judgment
• they do not accept feedback or constructive criticism
well and move forward with their ideas and decision
without much regard for others’ opinions
• helpful when decisions need to be made quickly to turn
a poor performing organization around
• people with low and unstable self-esteem tend to
prefer autocratic leaders whose powerful abilities they
believe in and in whom they can place their trust and
hopes
CRUCIAL CONVERSATIONS: A NECESSARY LEADERSHIP
SKILL
• a discussion between two people in which stakes are
high, opposing positions, and emotions are strong
Seven-step Process for Managing Difficult Conversations:
1. Start with the heart, which includes asking yourself what
you really want and what’s at stake.
2. Learn to look
3. Make it safe
4. Master your story
5. State your path
6. Explore others’ paths
7. Move to action
IMPORTANT LESSONS LEARNED FROM A PERSONAL
LEADERSHIP, INNOVATION, and ENTREPRENEURAL
JOURNEY
Remember the Three (3) Ds:
• Dream,
• Discover,
• Deliver
1. Dream Big and don’t let anyone steal your dreams Defining problems with
Problem-solving
effective solutions
2. Discover- always have a questioning spirit Aligning the subjective
Reality testing emotional with the objective
3. Deliver- Any big dream is worth the persistent effort it reality
take to achieve it Adjusting to changing
-Remain persistent through challenges or Flexibility
situations
“character builders” Coping successfully with
- Remember, how you think impacts how you feel Stress tolerance
adversity and strong emotions
and how you behave Resisting or delaying an
- Count your blessings daily Impulse control
impulse, drive , or action
- make it a habit to count at least three blessings Being happy and satisfied with
every morning as an attitude of gratitude paves the Happiness
one’s life and oneself
way for a happy, fulfilled life Having a positive attitude,
- Take great self-care Optimism especially during times of
- Stay humble and relatable adversity
- The most successful leaders are humble and
empower others to accomplish their dreams. They FIVE (5) PRACTICES OF EXEMPLARY LEADERSHIP
serve others. 1. Modeling the way –means to model the behavior that is
- Don’t feel guilty about saying no - overcommiting expected of others
can result to stress and burnout 2. Inspiring a Shared Vision- dreaming of dreaming of what
- Build teams that work well together can be accomplished with you and your team
- Be clear with expectations 3. Challenging the process- seeking and accepting
- Do not micromanage challenges
- Throw up, not down- find a trusted person who 4. Enabling others to act
outranks you or an outside friend to share 5. Encouraging the heart- finding people doing things right,
frustrations and talk through solutions and rewarding and recognizing them in ways that work for
- Learn to have crucial conversations and to provide them. Provide feedback. Be positive and constructive
constructive comments
- Be open, transparent, caring, and appreciative COACHING FOR SUCCESS
- Focus on the important, not urgent
Eleven (11) Suggestions on Ways to be an Effective Coach
UNDERSTANDING YOURSELF AND DEVELOPING AS A 1. Communicate clear expectations to group members
LEADER 2. Build relationships
3. Give feedback on areas that require specific
People Skills - the first and most vital for a leader improvement
4. Listen actively
15 People Skills (Competencies) you need to be Successful 5. Help remove obstacles
at Work and in Life 6. Give emotional support when and where needed
PEOPLE SKILL DEFINITION 7. Reflect content or meaning
Emotional self- Understanding one’s own 8. Give some gentle advice and guidance
awareness feelings 9. Allow modeling of desired performance and behavior
Expressing and standing up for 10. Gain a commitment to change
Assertiveness
oneself 11. Applaud good results
Being self-directed and self-
Independence
controlled FOCUS ON STRENGTH TO ENGAGE
Self-regard Accepting oneself as good - Engaged employees work with passion and connect
Self-actualization Attaining one’s full potential profoundly to their organization. They drive
Being aware of, and innovation and move the organization forward
Empathy
understanding others’ feelings
Being a cooperative and - Disengaged employees are essentially “Checked
Social responsibility constructive member of one’s out”, putting in time but not energy or passion
social group
Establishing and maintaining - Actively disengaged employees are not just
Interpersonal
mutually satisfying unhappy at work; he/she is busy acting out than
relationships
relationships
 unhappiness. They undermine what their engaged
coworkers attempt to successfully accomplish
*To engage self and others, one must use more of what
he/she is good at (strengths) and use fewer
Weaknesses
* Resolve to keep your workplace positive
* Cultivate a daily attitude of gratitude
4. Financial Wellness
- Being fully aware of your financial state and
budget, and managing your money to achieve
realistic goals

KEY STRATEGIES FOR OPTIMIZING HEALTH AND WELL a. Set aside time to evaluate your fiancés
BEING: A NECESSITY FOR EFFECTIVE LEADERSHIP b. Analyze money in, money out
-three months’ worth of credit card and bank
A recent study in the US of over 2,300 nurses from 19 statements should give you a clear picture of
healthcare systems found that depression was the leading income and expenses
cause of medical errors - identify how much money you have coming in
each month.
THE NINE DIMENSIONS OF WELL BEING - identify your fixed expenses (mortgage, utility
1. Physical wellness bills etc.)
Four healthy behaviors for better health - identify your variable bills (clothing, vacations,
a. Engage in 30 min of physical activity at least 5 emergencies, health etc.)
days a week c. Prioritize
b. Limit alcohol intake (1 drink a day for women, 2 d. Save rather than borrow
drinks a day for men) e. Protect yourself from big loss
c. Don’t smoke f. Find help
d. Eat at least five fruits and vegetables a day g. Find healthy outlets for your stress that cost
nothing
* Research has shown that people who engage in the 4 5. Intellectual Wellness
healthy lifestyle behaviors mentioned have 45% less heart - a person who values lifelong learning; fosters
disease, 66% less diabetes, 93% less depression, 45% less critical thinking, develops moral reasoning, expands
back pain, 74% less stress worldviews, and engages in education for the
2. Emotional Wellness pursuit of knowledge
- includes the ability to identify, express and Techniques to Keep your Mind Active:
manage full range of your feelings a. Read
- includes practicing techniques to deal with stress, b. Practice short periods of quiet time every day
depression, and anxiety, and seeking help when your c. Do not multitask; focus on one task at a time
feelings become overwhelming or interfere with everyday d. Disrupt your routine
functioning 6. Career Wellness
3. Cognitive Behavioral Skills Building - Engaging in work that provides personal
-the first step in cognitive behavioral skills-building satisfaction and enrichment and is consistent with
is to learn to catch your automatic negative thoughts your values, goals, and lifestyle will keep you
Tactics to help Optimize your Emotional Wellness: professionally healthy.
a. Engage in some physical activity each day a. Mindfulness on the job
b. Keep a journal of what causes you stress and activities to b. Cultivate a positive mind-set
help reduce it c. Multitask less, monotask more
c. Get at least 7 hours of sleep at night to avoid excess d. Purpose, pleasure and pride
cortisol from being released 7. Social Wellness
d. Learn about and practice mindfulness - our ability to effectively interact with people
around us and to create a support system that
*Manage your energy by taking short recovery breaks includes family and friends
throughout the day
*Read a positive-thinking book of your choice 5 min every Steps to Improve Social Wellness
morning to elevate your mood and protect yourself against 1. Disconnect from technology to take time to
negativity communicate with others
* When stressed, take just five slow deep breaths in and 2. Improve communication skills
out 3. Evaluate emotional intelligence
* Help others and be kind; compassion for other will help 4. Cultivate a positive attitude
you feel good, too 5. Take time to celebrate with and compliment friends and
*Talk to someone you trust about how you feel family members
Conflict Management

8. Creative Wellness
- valuing and participating in a diverse range of arts
and cultural experience to understand and
appreciate your surrounding world
- Allow yourself creative freedom without worrying
about whether you are doing it well, and take time
to appreciate the creative efforts of others.
9. Environmental Wellness
- recognizing the responsibility to preserve, protect
and improve the environment, and to appreciate
your connection to nature
- intersects with social wellness when you work to
conserve the environment for future generations
and improve conditions for others around the
world